Effects of High-Fidelity Simulation Training on Learning Outcomes and Satisfaction for Practising Registered Nurses: A Systematic Review and Meta-Analysis

Abstract

Background: Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised. Objective: To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses. Methods: In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline. Results: Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I2 = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I2 = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I2 = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [−0.04, 1.22], p = 0.07; I2 = 67%). Conclusion: Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted. Protocol Registration: PROSPERO (CRD42022358717). No Patient or Public Contribution.